Comparison of the Immediate Effects of Etomidate, Propanidid, and Thiopentone on Haemodynamics, Coronary Blood Flow, and Myocardial Oxygen Consumption

Patschke, D.; Ckner, J. B. Br; Gethmann, J. W.; Tarnow, J.; Weymar, A.

doi:10.1097/00132586-197702000-00017

Cited by 3 publications

(3 citation statements)

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“…However, this reduction in work was sufficiently transient not to be reflected in changes in myocardial blood flow and oxygen consumption. In contrast, there are reports of increased MVO 2 in anaesthetized dogs 7 , but decreased MVO 2 in isolated rabbit hearts 6 . This reinforces the concept that the cardiovascular response of a particular experimental paradigm to thiopentone is highly dependent on the conditions of the study and its methodology.…”

Section: Discussionmentioning

confidence: 91%

“…However, there is conflicting evidence regarding the magnitude of its effects on myocardial contractility, coronary blood flow and myocardial oxygen consumption [3][4][5][6] . For example, a number of studies reported that thiopentone decreased myocardial contractility [7][8][9] to varying degrees in animals anaesthetized with other agents. However, Turner et al 3 reported that contractility remained unchanged after thiopentone administration to initially conscious dogs.…”

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confidence: 99%

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The Effects of Short Intravenous Infusions of Thiopentone on Myocardial Function, Blood Flow and Oxygen Consumption in Sheep

Huang

Upton

Gray

et al. 1997

Anaesth Intensive Care

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The cardiovascular effects of slow (over two minutes) intravenous infusions of thiopentone 750 mg in conscious instrumented sheep breathing 100% oxygen were examined for 30 minutes following the start of the infusion. The maximum rate of rise of left ventricular pressure (an index of myocardial contractility) decreased significantly from 1 to 10 minutes, to a minimum of 45% of baseline. Heart rate increased by up to 33% above baseline from 0.5 min onwards. Both mean arterial pressure and cardiac output were decreased from between 1 and 7 min. Left ventricular minute work was transiently decreased, but left coronary blood flow and myocardial oxygen consumption showed little or no change from baseline. We conclude that in vivo, thiopentone administered at a relatively slow rate caused large reductions in myocardial contractility, and therefore cardiac reserve, in the absence of significant changes in myocardial blood flow or oxygen consumption.

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Section: Discussionmentioning

confidence: 91%

mentioning

confidence: 99%

The Effects of Short Intravenous Infusions of Thiopentone on Myocardial Function, Blood Flow and Oxygen Consumption in Sheep

Huang

Upton

Gray

et al. 1997

Anaesth Intensive Care

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“…Etomidate became an attractive option for rapid sequence intubation as the drug infrequently causes hypotension . The drug's minimal effects on cardiac output, myocardial oxygenation, and blood pressure have been well characterized in animals and humans . These favorable qualities are likely mediated by activation of α 2B ‐adrenoreceptors .…”

Section: Overview Of Etomidatementioning

confidence: 99%

Advantages and Disadvantages of Etomidate Use for Intubation of Patients with Sepsis

Cherfan¹,

Arabi

Al‐Dorzi³

et al. 2012

Pharmacotherapy

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Etomidate is a potent imidazole hypnotic used widely in single doses in the rapid sequence intubation of critically ill patients with sepsis due to its presumed hemodynamic safety, fast onset, and short duration of action. However, the literature is conflicting regarding the hemodynamic advantages of etomidate over other induction agents, and its safety in this population is a matter of strong debate in the critical care community as the drug is associated with suppression of adrenal steroidogenesis, which can last up to 72 hours after a single dose, primarily through potent inhibition of the 11β-hydroxylase enzyme. However, the clinical impact of this adrenal suppressive effect is not certain. The use of continuous-infusion etomidate in critically ill patients was abandoned more than 20 years ago due to reports of increased mortality. Nevertheless, mortality data of single-dose etomidate are still controversial, with no strong evidence of benefit over other agents and a tendency toward harm (keeping in mind the limitations of the available literature). Proponents of single-dose etomidate use in patients with sepsis suggest that the increased mortality associated with etomidate is merely a reflection of the patients' severity of illness and not related to the drug itself, whereas others believe that the drug causes true harm and increases mortality in this population. In view of the lack of a clear clinical advantage of etomidate over other agents used in rapid sequence intubation, it would be prudent to favor other agents until further conclusive evidence of etomidate safety is available in critically ill patients with sepsis.

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General anaesthetics and therapeutic gases

Knape¹

1978

Side Effects of Drugs Annual

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Comparison of the Immediate Effects of Etomidate, Propanidid, and Thiopentone on Haemodynamics, Coronary Blood Flow, and Myocardial Oxygen Consumption

Cited by 3 publications

References 0 publications

The Effects of Short Intravenous Infusions of Thiopentone on Myocardial Function, Blood Flow and Oxygen Consumption in Sheep

The Effects of Short Intravenous Infusions of Thiopentone on Myocardial Function, Blood Flow and Oxygen Consumption in Sheep

Advantages and Disadvantages of Etomidate Use for Intubation of Patients with Sepsis

General anaesthetics and therapeutic gases

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